2. IHE –Radiology Workflow – Present & Future Extensions EuroPACS 2002 Conference – Oulu / Finland Integrating the Healthcare Enterprise – –The Radiology Workflow – –Present & Future Extensions Dr. Nikolaus Wirsz Siemens Medical Solutions

3. IHE –Radiology Workflow – Present & Future Extensions EuroPACS 2002 Conference – Oulu / Finland 2 The IHE Radiology Workflow

4. IHE –Radiology Workflow – Present & Future Extensions EuroPACS 2002 Conference – Oulu / Finland 3 IHE Technical Framework Objectives: – –Reduce Redundancy of Data and Functions – –Enhance Data Integrity and Data Access – –Improve Data Consistency – –Close the Information Loop: HIS - RIS - PACS - Modalities Functional Components Interactions in the Healthcare Enterprise Technical Framework Specification – –IHE Data Model – –IHE System TransactionsOverview ( Enterprise Process Flow ) – –IHE Actors / Roles( Generic Functional Entities ) – –IHE Transactions( Interactions Between Actors ) – –IHE Integration Profiles( Solutions for Real-World Scenarios )

5. IHE –Radiology Workflow – Present & Future Extensions EuroPACS 2002 Conference – Oulu / Finland 4 ADT Patient Registration Image Archive Image Manager Image Display Image Creator Acquisition Modality Department System Scheduler – Order Filler – Order Placer Performed Procedure Step Manager Modality Worklist Patient Registration Patient Update Procedure Scheduled Images Availability Query Patient Update Procedure Update Images Stored Storage Commit Q /R Key Image Note Q /R Presentation Sates Storage Commit Images Stored PPS In-Progress / Completed PPS In-Progress / Completed PPS In-Progress / Completed Filler Order Management Placer Order Management Present. State Stored Q /R Images Key Image Note Stored Present. State Stored Key Image Note Stored IHE System Transactions Overview

6. IHE –Radiology Workflow – Present & Future Extensions EuroPACS 2002 Conference – Oulu / Finland 5 ADT Patient Registration Image Archive Image Manager Image Display Image Creator Acquisition Modality Department System Scheduler – Order Filler – Order Placer Performed Procedure Step Manager Modality Worklist Patient Registration Patient Update Procedure Scheduled Images Availability Query Patient Update Procedure Update Images Stored Storage Commit Q /R Key Image Note Q /R Presentation Sates Storage Commit Images Stored PPS In-Progress / Completed PPS In-Progress / Completed PPS In-Progress / Completed Filler Order Management Placer Order Management Present. State Stored Q /R Images Key Image Note Stored Present. State Stored Key Image Note Stored IHE System Transactions Overview External Report Repository Report ReaderReport Creator Report Manager Report Repository Report Submission Report Issuing Query Report Retrieve Report REPORT MANAGEMENTPRINTING Print Server Print Request with Presentation LUT Print Composer...And Even More Workflow Extensions ( IHE Year 4 ): –FINANCIAL WORKFLOW( Billing Transactions ) –POST-PROCESSING WORKFLOW( Post-Acquisition - CAD ) –BASIC SECURITY( Meeting HIPAA Requirements )

7. IHE –Radiology Workflow – Present & Future Extensions EuroPACS 2002 Conference – Oulu / Finland 6 ADT Patient Registration Image Archive Image Manager Image Display Image Creator Acquisition Modality Department System Scheduler – Order Filler – Order Placer Performed Procedure Step Manager Modality Worklist Patient Registration Patient Update Procedure Scheduled Images Availability Query Patient Update Procedure Update Images Stored Storage Commit Q /R Key Image Note Q /R Presentation Sates Storage Commit Images Stored PPS In-Progress / Completed PPS In-Progress / Completed PPS In-Progress / Completed Filler Order Management Placer Order Management Present. State Stored Q /R Images Key Image Note Stored Present. State Stored Key Image Note Stored IHE System Transactions Overview RIS HIS IMAGING: PACS Workstations Modalities

8. IHE –Radiology Workflow – Present & Future Extensions EuroPACS 2002 Conference – Oulu / Finland 7 IHE Goes Beyond Standards IHE = + Multi-Vendor + Workflow-Driven + INTEGRATION based on established medical IT Standards IHE = A Standards Harmonization Approach

9. IHE –Radiology Workflow – Present & Future Extensions EuroPACS 2002 Conference – Oulu / Finland 8 The 2 Workflow Basics in IHE 1)Scheduled Workflow: Enterprise Process Steps Under Normal Conditions: Admission / Registration, Order Entry, Scheduling, Images Acquisition,... 2)Patient Information Reconciliation: Exception Handling Example:Image Acquisition Completed for an Unidentified Patient

10. IHE –Radiology Workflow – Present & Future Extensions EuroPACS 2002 Conference – Oulu / Finland 9 Order Placer Performed Procedure Step Manager ADT Patient Registration Image Archive Image Manager Image Display Image Creator Acquisition Modality Department System Scheduler – Order Filler – Modality Worklist Patient Registration Procedure Scheduled Images Availability Query Images Stored Storage Commit Storage Commit Images Stored PPS In-Progress / Completed Filler Order Management Placer Order Management Q /R Images PPS In-Progress / Completed PPS In-Progress / Completed Scheduled Workflow

11. IHE –Radiology Workflow – Present & Future Extensions EuroPACS 2002 Conference – Oulu / Finland 10 Order Placer Performed Procedure Step Manager ADT Patient Registration Image Archive Image Manager Image Display Image Creator Acquisition Modality Department System Scheduler – Order Filler – Modality Worklist Patient Registration Procedure Scheduled Images Availability Query Images Stored Storage Commit Storage Commit Images Stored PPS In-Progress / Completed Filler Order Management Placer Order Management Q /R Images PPS In-Progress / Completed PPS In-Progress / Completed Patient Information Reconciliation ( e.g. Patient Merge ) Patient Update Procedure Update Patient Information Reconciliation

12. IHE –Radiology Workflow – Present & Future Extensions EuroPACS 2002 Conference – Oulu / Finland 11 –Year 1–Proof of Concept: - -Basic Scheduled Workflow –(Year 2–Integration Profiles ( Solutions for Real-World Problems ): - -Patient Information Reconciliation - -Access to Radiology Information - -Consistent Presentation of Images - -Presentation of Grouped Procedure - -Simple Image & Numeric Reports - -Key Image Notes Year 3–Consolidation ( Catch-Up with Real Products )  Expansion to France –– –– IHE Past – Present – Future ( 1999 – 2002 –... )

13. IHE –Radiology Workflow – Present & Future Extensions EuroPACS 2002 Conference – Oulu / Finland 12 –Year 4–New Integration Profiles: - -Post-Processing Workflow - -Charge Posting( Billing Transactions ) - -Basic Security( Audit Trails & Node Authentication )  Expansion to Germany, Italy, Japan –Year 5–Potential Integration Profiles for 2003: - -Teaching Files - -Clinical Trials - -Reporting Workflow( Interpretation Worklists ) - -Desktop Integration( HL7 CCOW )  Expansion to UK  Expansion into Other Domains ( Lab, Cardiology,... ) –– –– IHE Past – Present – Future ( 1999 – 2002 –... )

14. IHE –Radiology Workflow – Present & Future Extensions EuroPACS 2002 Conference – Oulu / Finland 13 A Multidimensional Expansion of Integration Dept Sched. ADT Order Mgt Image Mgr Modality 1 st Dimension: Vertical Integration for Radiology IHE Years 1, 2, 3, 4,... IHE Vision for Growth

15. IHE –Radiology Workflow – Present & Future Extensions EuroPACS 2002 Conference – Oulu / Finland 14 A Multidimensional Expansion of Integration 2 nd Dimension: Growing the Horizontal Healthcare Enterprise Integration Master Patient Index Clinical Patient Record Ordering Process... Dept Sched. ADT Order Mgt Image Mgr Modality Patient Registration IHE Vision for Growth

16. IHE –Radiology Workflow – Present & Future Extensions EuroPACS 2002 Conference – Oulu / Finland 15 A Multidimensional Expansion of Integration 3 rd Dimension: Increasing the Number of Vertically Integrated Departments Master Patient Index Clinical Patient Record Ordering Process Patient Registration R a d i o l o g y C a r d i o l o g y Laboratory P h a r m a c y O t h e r s... IHE Vision for Growth

17. IHE –Radiology Workflow – Present & Future Extensions EuroPACS 2002 Conference – Oulu / Finland 16 IHE Vision for Growth ADT/ Reg Lab/Path Radiology Cardiology Int Med Endoscopy Ophthalm Dental ER

18. IHE –Radiology Workflow – Present & Future Extensions EuroPACS 2002 Conference – Oulu / Finland 17 References: IHE Europe:http://www.IHE-Europe.org IHE North America:http://www.rsna.org/IHE Questions ?